“Currently there are no guidelines for assessment and management of fever specifically for community and primary healthcare workers in the sub-Saharan Africa region,” said Dr Robin Green et al. In a review published recently in the African Journal of Emergency Medicine. In response to this challenge, the authors developed a multidisciplinary consensus guide to assist pharmacists and primary healthcare workers to risk stratify and manage children who present with fever, decide when to refer, and how to advise parents and caregivers.
THE BASICS
“Fever is defined as body temperature ≥37.5°C and is a normal physiological response to illness that facilitates and accelerates recovery,” the authors said. “Although it is often associated with self-limiting illness, it causes significant concern to both parents and attending healthcare workers. Clinical signs may be used by pharmacy staff and primary healthcare workers to determine the level of distress and to distinguish between a child with a fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who could be managed conservatively at home.”
QUICK REFERENCE GUIDE FOR NURSE AND PHARMACY STAFF
Refer the child to a doctor if:
- The child is younger than three months of age.
- Child is not eating or drinking normally.
- The child is not behaving normally, e.g. non-responsive, lethargic, persistent and inconsolable crying, or cries when touched.
- Fever has been present for longer than 2 days (48 hours).
- Temperature is higher than 40°C.
- Persistent vomiting.
- Abnormal breathing.
- Convulsions.
- Non-blanching rash.
- Urine is very dark in colour, and/or the child cries when passing urine.
- Swelling of a limb or joint.
- The child looks very ill or has signs of dehydration or shock: sunken fontanelle, dry mouth, absence of tears, sunken eyes, poor overall appearance
ANTIPYRETIC MEDICATION
Either paracetamol or ibuprofen (not both) can be used to make the child more comfortable.
Dose of antipyretic medication for infants and children older than three months of age:
- Paracetamol: 15 mg/kg body weight (up to 1 g) every 6 hours as necessary (the maximum daily dose is 90 mg/kg or 4 g in total)
- Ibuprofen: 10 mg/kg body weight every 6 hours as necessary (the maximum daily dose is 40 mg/kg)
Note. Table reprinted [adapted] from Management of acute fever in children: Consensus recommendations for community and primary healthcare providers in sub-Saharan Africa by Dr Robin Green et al., 2021, African Journal of Emergency Medicine, Volume 11, 284. Copyright 2021 by Elsevier Ltd.
“Care must be taken not to overdose medications and clear instructions should be given to parents/ caregivers on managing the child at home and when to seek further medical care,” concluded Dr Green et al.
